Widex guidelines on tinnitus
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Widex guidelines on Zen as a Tinnitus therapy.
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Widex guidelines on tinnitus
- 4. HEARING AIDS CAN OFFER EFFECTIVE SOUND THERAPY WIDEX TINNITUS GUIDELINES /17 Amplified sounds reduce stress associated with tinnitus – aids relaxation Amplified sounds reduce the contrast to silence Can move focus away from the tinnitus
- 6. WIDEX TINNITUS GUIDELINES WIDEX TINNITUS GUIDELINES /17 3 THE USE OF SOUND IN TINNITUS MANAGEMENT 11 ESTABLISHINGREALISTIC EXPECTATIONS 1 COUNSELLING ABOUT TINNITUS 2 ASSESSING THE TINNITUS 4 TINNITUS AND STRESS 5 MUSIC AND STRESS 6 INTRODUCING ZEN 7 SELECTING HEARING AIDS 8 PROGRAMMING 9 FINE TUNING ZEN 10 WHEN TO USE ZEN 12 FOLLOW UP VISITS
- 9. STRESS, MUSIC AND ZEN STRESS WIDEX TINNITUS GUIDELINES /17
- 15. ELEMENTS FOR YOUR DISPOSAL WIDEX TINNITUS GUIDELINES /17
- 17. THANK YOU!
Editor's Notes
- Tinnitus Guidelines - 17. december 2010
- Before telling you about the new Widex Tinnitus Guidelines, this presentation will explain the principels in tinnitus management in general and how this includes the use of sound. Tinnitus Guidelines - 17. december 2010
- The key to tinnitus therapy is to break the link between tinnitus perception and the negative or fearful emotions associated with it. Habituation occurs when the client considers the tinnitus to be an irrelevant stimulus , just like many other environmental sounds including the humming of a refrigerator or low level traffic noise. So anything to make the tinnitus sound “irrelevant” will be helpful. There are two key components: Counseling Can make the clients able to control the negative reactions to tinnitus through education (i.e., the more you know, the more you control) Sound stimulation Can change the tinnitus-to-background ratio (but not nature of tinnitus) to facilitate habituation, as well as aid relaxation to break the vicious cycle of tinnitus leading to stress and stress making the tinnitus worse. CLICK : The sound used for sound stimulation purposes can be: amplified sound from hearing aids Environmental sounds like Noise from noise generators and Music – especially music that fulfill certain criteria, as I will explain in details later in this presentation Tinnitus Guidelines - 17. december 2010
- Hearing aids by themselves have been a great tinnitus tool because: As a stimulus to mask the tinnitus – amplified everyday sounds reduce the contrast to silence As a stimulus to “relax” the emotion control center of the brain so it does not focus on tinnitus and its emotional consequences – successful communication relaxes the person – causing less stress and fatigue. The amplified sound from the hearing aids can also help the client to focus on for example communication or environmental sounds, instead of focusing on the tinnitus. Tinnitus Guidelines - 17. december 2010
- But why is music useful in tinnitus management? From a physiological perspective, music is known to produce changes in heart rate, blood pressure, respiration rate and muscle tension as well as decreased skin temperature and increased skin conductance, tears, and chills. So, when people study the effect of music or study the changes in emotions by music, measuring the person’s physiological indices often give a cue as to the effectiveness of music (or whatever intervention) has on the person. Knowing this about music makes it possible to choose music that tends to relax people. Studies has shown that slow music with no fast changes in rhythm or pitch can make people relax, but it is also a matter of preferences. The Zen tones in Widex hearing aids are developed using the knowledge on the relaxing effects of music. Tinnitus Guidelines - 17. december 2010
- Counseling is one of the oldest ways of helping people with tinnitus, and it still is a very important part of tinnitus management (Tyler et al: “Psychological Treatments for Tinnitus” in Tinnitus, theory and management (2004). When being provided with knowledge about typical causes and effects of having tinnitus, the client is able to act in a more appropriate manner. For example when realising that there is a link between stress and tinnitus, the client can focus on how to be more relaxed and less stressed. A fear that the tinnitus is caused by a life-threatening disease or that your going mad, can be as demanding on the psyche as tinnitus it self. Finally to give the client hope, that there is actually things that can be done to help him be less bothered by the tinnitus even though there is no cure is also very important. Tinnitus Guidelines - 17. december 2010
- Determining how the tinnitus affects a client’s daily life is essential in deciding on the degree and nature of intervention. It is also important to measure the client’s reaction to the tinnitus so that you have a baseline from which you can assess future progress. Subjective scales are available that can typically be completed by the client in the clinic in less than five minutes. Focusing on the loudness of the tinnitus is on the other hand not necessary, since studies can’t find any relation between loudness and the degree of annoyance (Craig & Sandridge (2004). Tinnitus Questionnaires. In Snow, J. B. (ed.) Tinnitus Theory and Management. London: BC Decker) [ THI, Tinnitus Handicap Inventory is a questionnaire that is available on the internet in several languages. Other examples are THQ, Tinnitus Handicap Questionnaire and TRQ Tinnitus Reaction Questionnaire] Tinnitus Guidelines - 17. december 2010
- As mentioned in the beginning fo this presentation, music can be an exellent tool for relaxation, but there is also some aspects of music that goes in the opposite direction of what we believe in when it comes to helping people with tinnitus. As you can se on the slide music and Zen shares som characteristics: music can be chosen to meet individual preferences, and Zen can be adjusted to meet the individual preferences. Both can be soft and slow paced. But the fact that the Zen tones do not follow a recognizable pattern induces passive listening, where it’s reasonable to assume that music that typically has some repetition of lyrics or chords cuases active listening. Another way that Zen has an advantage is that when wearing hearing aids, the Zen option is always available to be used in the way that preferred. Music will always need some kind of player, and will not be accessible always or even appropriate. Tinnitus Guidelines - 17. december 2010
- Since we need to take individual preferences into account, when providing the client with Zen for relaxation purposes, each of the five different Zen styles available can be adjusted according to pitch, tempo and volume via the settings panel in the Compass fitting software. To make sure that Zen can be heard even though having a hearing loss, the hearing aid takes the hearing loss into account. To find out which Zen style is preferred the client should have the opportunity to listen to the style. Each of the styles – Zen Aqua, Zen Coral, Zen Green, Zen Lavender and Zen Sand - can be played to the client via the Settings panel which are accessible when choosing the Zen program in the program starter bar in Compass. It is also possible to choose whether the microphone should be on or off – something that we will look into on the next slide Tinnitus Guidelines - 17. december 2010
- When a easy fitting is needed it would often be relevant to fit two almost identical Zen programs (choose Zen in program slot 2 and 3 via the Program manager in Compass) for the client. The only way those two programs should differ is the first having the microphone turned on and the second having the microphone turned off. The purpose of having those two programs, is to give the client the possibility to use Zen in different situations. Zen Aqua is in a resent study shown to be the Zen style preferred by most hearing aid users and for hearing aid users who like this right away, there is no need to play to him the other Zen styles. When the right tempo, pitch, and volume is found, the settings are just repeated in the second Zen program. Of course there is situations where clients are not satisfied with the default Zen Aqua style, and other styles need to be played to him, and there will be clients who would like more than two programs or different Zen styles or settings to choose from. This is of course up to you how detailed and introduction and how detailed a fine tuning you want to do. Tinnitus Guidelines - 17. december 2010
- This graphic indicates the main setttings described in the previous slide and how we see their application. The master program – or other acoustic programs – should be used when hearing is critical and where Zen would interfere with speech understanding Hearing aid + Zen program is for daily use and can be described as a “set and forget – program” Zen only can be used for meditation and relaxation purposes Beside this, the client should be told to avoid complete silence which can enhance focus on the tinnitus. Tinnitus Guidelines - 17. december 2010
- Setting expectations is natural step in all rehabilitaiton work. It is of special importance when you are dealing with tinnitus clients especially when the impact of the tinnitus is considered high. Talk with the client about what goals are important and what it will take to achieve them. Ultimately, the quality of life is the main issue, and the use of amplification and Zen can help the client achieve improvement in this area. Setting expectations is a process where some expectations may need to be sharpened or adjusted most importantly it is important to consider both short-term expectations and long-term expectations. Along with talking about what to expect, a follow up plan needs to be scheduled. Since finding a way to live with tinnitus for many people takes time, the follow-up plan described includes session after 6 month and every 6 month from that time, until termination is decided. It can be necessary to stress the importance of looking at tinnitus awareness instead of looking at the tinnitus loudness. The follow up visits should also include the assessing of progress. This can be done by using the subjective measures or scales used to establish the baseline tinnitus handicap or reaction and compare to the pre-fitting scores. Tinnitus Guidelines - 17. december 2010
- The Zen and Zen noise client book is a tool for hearing care professionals to be used in the dialouge with clients. In Widex Tinnitus Guidelines you will find references to this tool making it easy to find a way to explain tinnitus, hearing losses, the use of music and Zen to clients. Tinnitus Guidelines - 17. december 2010
- So to sum up the essentials in this presentation: The main elements in tinnitus management procedures in general are sound stimulation and counseling. By using Widex hearing aids you can use both amplified sound, Zen tones and noise in the tinnitus rehabilitation depending on needs and preferences. And now you’ve got Widex Tinnitus Guidelines for your disposal that together with the Zen and Zen Noise flip-over book is a tool that can be used when you want to offer Zen for those of your clients that are bothered by tinnitus. Tinnitus Guidelines - 17. december 2010